Today’s “Got Questions?” answer comes from speech-language pathologists Cynthia Green, Kameron Beaulieu, and Jill Dolata (left to right in photo) of the Autism Speaks Autism Treatment Network (ATN). Their ATN work at the Oregon Health & Science University’s Child Development and Rehabilitation Center involves individualized parent training using a 24-week program that improves children’s social communication skills.
Today, parents and therapists have many new applications and devices that support a child’s nonverbal communication. First and foremost, however, we strongly recommend an insightful look at how your nonverbal child communicates—in other words, how he sends messages to others.
As you and other parents of children with autism know well, non-verbal does not mean non-communicative. So we always want to start with a good understanding of children’s current communication level before attempting to help them move to the next level.
We regularly use the Communication Matrix, a skills assessment designed to evaluate children’s communication abilities. This tool is unique in measuring all possible communicative behaviors, including: pre-intentional (involuntary actions, including crying when wet or hungry); intentional (actions such as fussing and turning away that are not primarily intended for communication); unconventional (tugging, crowding to get attention); conventional communication (head nodding, pointing, etc.); concrete symbols (pantomime, “buzzzzz” to mean “bee”); abstract symbols (single words, manual signs); and language (oral and written word combinations, American Sign Language).
To be successful communicators, children need to see that their actions influence those around them, and they must want to communicate. Sometimes, it’s difficult to determine when nonverbal children are sending intentional messages—particularly when they prefer to play by themselves, engage in self-stimulating behaviors or have difficulty sustaining interactions.
There are several programs designed to initiate positive interactions and increase communication in children with autism, including First Things First, Indirect Language Stimulation, DIR/Floortime, the Hanen program, the Early Start Denver Model, and the Autism Parent Training Program. These programs have many similar components including putting yourself at your child’s eye level, allowing your child to direct activities (following his lead), and imitating your child’s behavior. These strategies help forge a connection of interests between you and your child and can support your child’s desire to communicate.
Once children communicate using concrete or abstract symbols, they may benefit from having access to additional communication tools. It helps to remember that we all use a variety of communication methods, including eye contact, facial expressions, body language, tone of voice and gestures. So you might want to start with a system of gestures or sign.
Other low-tech tools include picture symbols and PECS . Some children seem to respond to tangible symbols such as an actual key for “let’s go outside” or a cup for “I’d like a drink.” From the use of tangibles, families can move to photographs of familiar items and eventually to more abstract symbols. Children at this stage may benefit from Tangible Symbol Systems.
Finally, parents and therapists now have access to a number of technological devices and options, from a tape player with simple buttons for playing prerecorded messages and keyboards for typing messages to sophisticated voice output devices and specialized iPhone/iPad applications.
We hope you’ll have fun exploring these options with your child, ideally under the guidance of a therapist well versed in the best evidence-based practices. And please stay tuned for the fall release of the new Autism Speaks ATN brochure on Visual Supports and ASD. We’ll be posting it for free download on the ATN’s Tools You Can Use webpage.
Readers are urged to use independent judgment and request references when considering any resource associated with diagnosis or treatment of autism or the provision of services related to autism. Autism Speaks does not endorse or claim to have personal knowledge of the abilities of references listed. The resources listed in these pages are not intended as a referral, or endorsement of any resource or as a tool for verifying the credentials, qualifications, or abilities of any organization, product or professional. The contents of this blog are solely the responsibility of the authors and do not necessarily represent the official views of Autism Speaks, the Autism Treatment Network and/or the Autism Intervention Research Network on Physical Health.
My child is nonverbal – what are some intervention methods that might help my child communicate better?
“Got Questions?” is a new weekly feature on our blog to address the desire for scientific understanding in our community. We received over 3000 responses when we asked what science questions were on your mind. We answered a few here and will address the other themes we received in this weekly post.
Many individuals with autism do not use spoken language to communicate. It is estimated that approximately 25% of individuals with ASD are nonverbal. Despite early traditional approaches such as speech, occupational and behavioral therapy, some children still remain unable to communicate their wants and needs. A recent study found that some children with ASD do not develop spoken language until after the age 5 years. On-going speech and language intervention can promote the development of speech in nonverbal children who are of school age. In addition, there exist specific intervention approaches that can be helpful for some individuals, such as PROMPT, an intervention approach especially designed for children with motor-speech disorders.
Speech and language specialists recommend a variety of alternative and augmentative communication (AAC) devices for individuals who are nonverbal. A commonly used system is the PECS picture exchange system (PECS). PECS has been used with individuals with ASD of all ages. One advantage is that it doesn’t require expensive materials, relying on a set of picture symbols that can be used to make simple or complex requests and other statements. The symbols are typically placed in a communication book. After the child or adult learned to make spontaneous requests. The individual can then learn to construct sentences. . Other AAC methods include the following:
- Gestures and sign language
- Pencil and paper
- Communication books or boards
- Keyboards and other electronic devices
The iPhone and iPad are being used as ACC devices. These new interactive technologies have invited a wave of new applications to benefit individuals on the spectrum, especially those who are nonverbal. Many of these applications incorporate the advantages of the PECS system of offering a stock of visual images as well as the ability to personalize using one’s own images. Two of the most popular programs are Proloquo2go and iPrompts.
Although the use of these devices have not been tested in rigorous clinical trials, those trials are underway and early anecdotal reports are positive. Connie Kasari, PhD. (UCLA) leads an Autism Speaks’ funded clinical trial comparing two different interventions for young nonverbal individuals. Having previously used traditional keyboarding devices, Dr. Kasari has found that the iPad with speech generating software offers a great alternative to expensive AAC speech generating devices. However Dr. Kasari also adds, that these devices “Work best in therapy sessions with a child who has not yet figured out that they can surf the web with it, too!”
Of course, this potential distraction is also an advantage. These new applications are hosted on the multifunctional iPhone and iPad platforms. HandHoldAdaptive, the creators of iPrompts, have launched AutismTrack, a new portable journaling tool that enables caregivers to track therapies, medication and behavior. Developers continue to create new apps to address the challenges of those on the spectrum, making these new tools even more powerful for managing the everyday needs and desires for individuals on the spectrum.
ACC Institute: http://www.aacinstitute.org/
To locate a speech-language pathologist, visit http://www.asha.org/findpro/default.htm
This post is by Sheila Sullivan. Sheila, a veteran member of the Autism Speaks awareness team, also manages the organization’s branding, merchandising and licensing. She has a tendency to get really excited about things that help people in the autism community directly and even more excited when people and companies step forward to help Autism Speaks fulfill its mission. You will be hearing more from Sheila, no doubt!
Necessity is the mother of invention, as the saying goes. The best ideas are often born from a need that isn’t met – and iPrompts®, from HandHold Adaptive, is one of them. When the inventors of this App for iPhone® and iPod Touch® learned that their son with autism, like many other children who struggle with developmental and language disabilities, greatly benefits from the structure and clarity provided by visual aids, they used picture-based schedules and choice boards to help him transition between activities, communicate his needs, and stay on task. However, they were frustrated by the tools available – printing and laminating pictures, losing plastic symbols magnets, transporting bulky notebooks – finding them unwieldy and not nearly as portable as they would like. They channeled their frustration into designing something better. The result: HandHold Adaptive and its first product, iPrompts®, were born.
iPrompts® is, in essence, PECS for iPhone® and iPod Touch® users – caregivers, parents, teachers – that makes use of technologies available to make this previously bulky, unwieldy process portable and simple. HandHold Adaptive is donating 10% of the sales of the iPrompts® app to Autism Speaks.
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